QUANTIFYING THE BENEFITS OF ENHANCING MEDICATIONS ON DRIVING PERFORMANCE: COMPARING OROS MPH VS. se-AMPH ER IN DRIVING SAFETY OF ADHD TEENAGERS AS CASE EXAMPLE

摘要

Driving simulation is the best way to safely and reliably assess the impact of medical parameters on driving in a controlled, replicable environment, Driving performance should be evaluated using a composite driving score, since the pathway to impaired driving is highly idiosyncratic and could involve any number of individual driving parameters. Although simulators still do not have accepted standards for hardware, driving scenarios, or performance variables, we propose a partial solution to permit comparisons of composite scores across simulators. We recommend presenting simulator data via a standardized average effect size, which we call the Impaired Driving Score (IDS). We describe how the IDS is calculated, and present data comparing 16 male and 15 female teenage drivers with ADHD who participated in a double-blind, placebo-controlled, crossover study. Using an equivalent-dose regimen, we compared the effects of 72 mg of OROS MPH (Concerta), 30 mg of se-AMPH XR (Adderall XR) and placebo on driving performance. Participants drove our Atari Research Driving Simulator at 5, 8, and 11 pm under all three medication conditions with at least a week between conditions/drives. The primary outcome measure was participants' IDS. Across all three times, performance on Concerta was superior to placebo (p=.005), while Adderall XR was not (p=.14). When analyzed separately, however, only one variable was statistically significant (seconds spent speeding, p<.01). Composite driving scores permit the comparison of driving performance across various experimental conditions and with a normative database. Furthermore, since the IDS is based on a multi-faceted assessment of driving performance, it is less vulnerable to random effects and offers a more robust indicator of driving performance.